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Global Strategy Elder Abuse


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A presentation to the 2002 CASSW conference on the World Health Organisation project of developing global strategies against elder abuse.

A presentation to the 2002 CASSW conference on the World Health Organisation project of developing global strategies against elder abuse.

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  • Transcript

    • 1. The WHO-INPEA Global Strategy for the Prevention of Elder Abuse Silvia M. Straka Gerry Bennett Alexandre Kalache Silvia Perel Levin
    • 2. Agenda
      • Background and context
        • Elder abuse: definition
        • Ageism
        • The global context: population ageing
      • WHO-INPEA action research project
      • Research component: two key findings
      • Implications for social work
    • 3. Elder Abuse Defined
      • Elder abuse is a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person
      • (INPEA-WHO definition, adopted from Action on Elder Abuse, 1995)
    • 4. Some Categories of Elder Abuse
      • Physical abuse
      • Neglect (physical, emotional)
      • Psychological and verbal abuse
      • Financial/material exploitation
      • Violation of rights
    • 5. Consequences of Elder Abuse
      • Consequences are devastating and include:
        • Increased mortality and morbidity
        • Poor quality of life
        • Emotional distress
        • Loss of property and security
    • 6. Ageism
      • Elder abuse is one of the most extreme forms of ageism
      • Ageism remains one of the least recognized forms of oppression
      • Ageism intersects with other forms of oppression (e.g. gender, race, class, etc.)
    • 7. Lack of a Structural Analysis
      • While links to ageism have long been acknowledged, theory and practice remain focused at the micro-level
      • Elder abuse has been constructed by professionals and experts
      • It is viewed as a problem of individual and family pathology
      • Voices of older adults are missing from the discourse
    • 8. Global Context: Population Ageing
      • The problem of elder abuse assumes new significance in the context of global ageing
      • By 2025, the global population of people over age 60 will double to 1.2 billion
      • 1 million people turn 60 every month
      • 80% of these are in the developing world
    • 9. WHO Response
      • Recognized the problem and initiated an action-research project
      • Partners:
        • INPEA
        • HelpAge International
        • Researchers from various academic institutions
    • 10. Goals of the Action-Research Project
      • Exploratory research component:
        • Attitudes, beliefs and perceptions about elder abuse held by older adults and health care professionals
      • Action component:
        • Develop global action strategies against elder abuse by key stakeholders
    • 11. Research Methodology
      • Focus groups in 8 countries
        • 5 developing countries:
        • Argentina, Brazil, India, Kenya, Lebanon
        • 3 developed countries
        • Canada, Austria, Sweden
        • 8 focus groups per country
          • 4 groups for health care professionals
          • 4 groups for older adults
    • 12. Qualitative Data Analysis
      • Local experts analyzed the data and produced national reports (translated into English)
      • National reports were subject to further analysis and synthesis
      • Synthesis report was produced
    • 13. Stage II: Action Component
      • An international working group of key stakeholders met in Geneva in October 2001
      • National reports and the international syntheses were presented and provided the basis for the development of concrete action strategies
      • The final report, aimed at policy makers, was launched at the UN World Assembly on Ageing in Spain in April, 2002
      • The action strategies are in process of implementation by the project partners
    • 14. Key Focus Group Themes
      • How do older adults and health care workers understand:
        • the roles of older adults in their societies and the problems they face
        • the problem of elder abuse and its possible solutions
    • 15. Two Key Findings
      • The findings provide the basis from which to begin to redefine elder abuse to incorporate a broader perspective.
      • In particular, two key categories of abuse were identified:
      • Structural and societal abuse
      • Disrespect and ageist attitudes
    • 16. Structural and Societal Abuse
      • Participants from developing countries primarily blamed governments and structural factors for the mistreatment they suffer
      • Responsibility for prevention and intervention is clearly seen as a government responsibility
      • “ societal abuse”: most important type of abuse and root cause of most other types of abuse
      • Covers a wide range of issues
    • 17. Examples of Societal Abuse
      • Inadequate pensions
      • Inadequate accommodation
      • National economic crises
      • Impacts of changes in social roles
      • Inadequate funding and access to heath and social services
    • 18. Disrespect and Ageist Attitudes
      • Experiences of disrespect are viewed by older adults as:
        • a cause of all other forms of abuse
        • an important form of abuse in itself
      • “Respect is better than food and drink”
      • “One rude word said to an old man is stronger than stabbing him with a knife”
      • Lebanon report
    • 19. Some Causes of Disrespect
      • Changes in societal values
      • Negative images and stereotypes of older adults through the media
      • Westernization as bringing new attitudes and values
      • Younger generation particularly disrespectful
    • 20. Disrespect in the Health Care System
      • “ The disoriented elder, who may be intoxicated by medication, is taken [and treated] as a headstrong child. This is quite violent; a professional to take out the prothesis, take out the device, remove the eyeglasses [from the older person], then he [the older person] agitates. When he agitates, [the professional] medicates … this is violence; there are also cases in which he [the professional] says, “I won’t let your daughter in if you keep [behaving] like that.”
      • Brazil report
    • 21. Disrespect in Government and Commercial Institutions
      • “At the post office or at the railway station you are not supposed to speak too slowly and you are treated badly when you have a hearing problem.”
      • Austria report
    • 22. Disrespect on Public Transport
      • “Disrespect starts from the moment the elder gets to a bus stop. When he hails the bus to stop, the first thing the driver says [to himself] is, ‘Don’t stop here as it is full of six-five [people aged 65 or over].’ The elder hails, but them [drivers] keep going. Or they stop way ahead, so the poor old guy has to run to catch the bus. It is mean.”
      • Brazil report
    • 23. Disrespect in Society at Large
      • “[Older adults] feel disregarded, insulted, ignored by government or social security agencies, or mistreated in shops, in public transport, etc.; the general feeling is that the elderly are pushed to the edge of society.”
      • Austria report
    • 24. Some Implications for Social Work
      • Implications for theory:
        • challenges the existing micro-level conceptualization of elder abuse and identifies directions for theory development
      • Implications for policy:
        • inadequate social policies affecting older people can result in conditions that increase the risk of elder abuse
      • Implications for practice:
        • practitioners need to understand the structural roots of the problem and engage in social action
    • 25. ….Implications
      • Implications for research:
        • new research questions will be generated
        • These “new” forms of elder abuse, such as disrespect and its impact on older people, need to be studied
      • Implications for education:
        • elder abuse should be framed as a social justice issue
        • the present micro-level approach to teaching elder abuse practice needs to be situated within a structural analysis
        • Elder abuse courses need to include discussion around macro-level interventions to the problem
        • International social work courses should include references to problems of ageing, including elder abuse
    • 26. Importance and Contributions of the Project
      • First multi-country set of information about elder abuse
      • Richness of data
      • Findings throw new light on how to perceive and approach elder abuse
      • WHO has a unique position, which permits it to:
        • convert the outcomes of the discussion into concrete action points
        • assist primary health care workers globally to prevent elder abuse
    • 27. Missing Voices Report
      • WHO/INPEA (2002). Missing voices: Views of older persons on elder abuse. Geneva: WHO.